Accounts Receivable Management

The objective of successful Accounts Receivable Management seems simple enough; however, maintaining an efficient cash flow by obtaining timely compensation for the resources used in providing healthcare in a facility is anything but simple. And yet, effective A/R management is critical to maintaining positive cash flow and especially important to rural, community, and acute care hospitals.

  • Do you have a clear and concise KPI reporting system?
  • Do you hold personnel in the revenue cycle individually accountable to key revenue cycle metrics?
  • Do you hold regular and frequent revenue cycle committee meetings?
  • Does your organization view the revenue cycle as an interdisciplinary approach?
  • Are all senior executives aware of the current revenue cycle initiatives?
  • Are clinical leaders held accountable for their portion of revenue cycle dependencies?

Business Challenge

It's becoming harder for facilities to receive reimbursement for their services. Rules and processes from payers have become increasingly complex resulting in more denials, underpayments, and lost or ignored claims. Regulatory challenges, including those brought on by the Patient Protection and Affordable Care Act are on the rise and will continue to become increasingly difficult.

But the demand to provide quality affordable care to your community never goes away.

According to the Center for Medicare and Medicaid Services (CMC) only 70% of claims are paid the first time they are submitted.  Unfortunately, the other 30% of claims are either denied (20%) or lost/ignored (10%). More importantly, a full 60% of those claims are never resubmitted to payers; meaning many rural and community hospitals fail to collect as much as 18% of all claims.

By industry estimates, underpayment, or failure of the facility to collect the full amount under their payer contracts, can account for a further 7-11% shortage in the amounts due to the facility.

Best Practices

Key Performance Indicators

  • Assigned accounts over 90 days
  • Denial percentage
  • Cash collected to net revenue
  • Unbilled accounts
  • Number and dollar amount

Catch potential denials before submitting to payers. Develop processes and rules to identify claims that are likely to be denied.

Organize and manage contracts with payers. Identical patient services may be reimbursed at different amounts from individual carriers. Business processes and technology solutions can improve the ability to compare payments received versus contacted payment schedules. These same efforts can be useful in forecasting A/R based upon recently billed services.

Age receivables daily. Payment schedules vary between payers. A Medicaid reimbursement might be considered late if not received in 15 days, while many payers require 30-45 days. Relying on the traditional practice of aging receivables in 30, 60, or 90 day categories doesn't make sense and may unnecessarily prolong reimbursement from some payers.

Develop quality reports. Facilities manage thousands of patients and hundreds of payers across a complex environment to deliver quality healthcare services and then to secure reimbursement for those services. Managing receivables on an account-level basis may disguise larger issues with the revenue cycle and hinder visibility into processes that restrict cash collection.

Pursue best practice models for collection. Match employee skills with the appropriate task. Track and elevate visibility to all denials, underpayments, waived fees, etc. Develop processes for evaluating the cash value of denials and underpayments and assign resources appropriately.

Services

re|assess

Revenue Cycle Assessment

The revenue cycle challenges faced by hospitals today are enormous. Charge Capture, Coding, reimbursement and compliance issues plague larger facilities as well as rural and community hospitals. Resources to ensure appropriate reimbursement for services provided are stretched. re|assessre|solution’s revenue cycle assessment provides the foundation to optimize your revenue cycle and performance. <more>

re|source

Interim Staffing

Hospitals are constantly struggling with retaining qualified personnel (particularly with smaller community hospitals).  Replacing key personnel in the business office may require training existing personnel and establishing procedures and policies that enhance a new manager’s ability to perform.  Occasionally, locating a new employee takes time to find a good fit.  The facility may not have the luxury of reduced cash flow while recruiting takes place.  re|solution has qualified and experienced personnel ready on a moment’s notice to assist as Business Office Managers, Coders, Billers, Collectors and Cash Posters.  Business office interim staff are placed on-site for as long as they are needed. <more>

re|cover

Cash Acceleration

If you have a temporary backlog of aged receivables due to a recent system conversion, employee turnover, management changes, increased volume, or other disruptions to the business office, re|solution provides relief by placing personnel on-site to clean up the backlog and provide customized training and support for your business office personnel to prevent the backlog from recurring. <more>

re|store

Insource Your Business Office

The regulatory atmosphere and relentless pressure of increasing complexity combine to create staggering challenges while introducing risk to your facility's ability to get paid for the services you are expected to deliver to the community.

  • Increased federal and state regulatory, oversight, and audit pressure continues to drain resources and cash from hospitals while these same agencies increase their focus on billing and coding compliance, often issuing stiff penalties
  • Reductions in reimbursement, increasing self-pay or higher deductibles combine to make cash collection critical
  • Revenue and cash collection are increasingly put at risk due to inadequately trained staff, the inability to afford the best technology and tools, and the struggle to implement and maintain best revenue cycle practices

Your facility has a significant investment in a billing system but does not have the personnel available to adequately manage and staff the business office under this ever-changing environment . re|solution performs all business office functions using your facility's existing billing software and utilizing a mix of your staff, our experienced personnel on-site and from one of our regional billing centers. This treatment is most effective in managing business office costs and relieving billing headaches, without the added expense of replacing your existing system. <more>

re|wind

System Conversion A/R Wind Down

Your new system conversion date is nearly here. You and your leadership team and staff have dedicated a large amount of time to implementation, planning and training while at the same time trying to maintain current operations. System implementations are complex and at times can be overwhelming, and despite your best efforts, key performance indicators can begin to move in the wrong direction. <more>

Benchmark

How does your facility compare nationally with other facilities of your respective size?

re|solution is an expert in rural, community, and critical access hospitals, providing superior accounts receivable management, revenue cycle analysis, training, charge capture reviews, interim staffing, and an array of other business office services.  If you are interested in knowing how the performance of your business office compares with demographically similar facilities and where your opportunities exist to increase CASH. Please complete the form below and return it to us by fax or e-mail.  In return, we will provide you with a free benchmarking analysis.  We will also make ourselves available for a discussion and explanation of the data. You may view a Sample Report.

Benchmark Indicator Analysis

Please click to complete the Benchmark Indicator Analysis online and we will return your results to you shortly. Your information is confidential.

If you prefer you may print and complete the form and Fax to (303) 847-0417 or e-mail to analysis@ereso.com.

Case Studies

Towner County Medical Center Increases Cash by Over 30% in First Year of Insource

TCMC’s leadership collaborated with re|solution using an Engagement Management Action Plan for an efficient insource transition. The plan outlined a variety of milestones and goals designed to optimize revenue cycle operations. TCMC employees were transitioned to re|solution, retaining jobs in the community.

Dallam-Harley Counties Hospital District increases cash and reduces expenses

In partnership with re|solution, Dallam Hartley deployed re|store™. re|solution placed a Revenue Cycle Manager onsite to assist with training current staff, securing additional staffing, stabilizing the DNFB and billing. The staff worked aggressively to meet milestone goals.

Ohio Valley Medical Center and East Ohio Regional Hospital find over $16 million in Net Revenue

Ohio Valley Medical Center deployed re|assess™ complemented by an experienced re|solution BOD to assess staff and staffing levels, provide training and accountability. The re|solution proprietary tools were utilized and left behind for sustainable improvement and success.

Brownfield Regional Medical Center insources, reducing aged AR by 2.5 Million

Brownfield Regional deployed re|store™ complemented by a re|solution project manager to assist in training internal staff, collecting aged accounts receivable, reducing DNFB, and optimizing reimbursement.

Marshalltown Medical & Surgical Center Finds Additional Cash

Marshalltown Medical and Surgical Center deployed re|assess™ complemented by an experienced re|solution manager to identify missed opportunities for reimbursement while providing training to key staff and implementing sustainable and proven improvements to the facility’s processes.

Muenster Memorial Hospital achieves a significant reduction of Accounts Receivable and DNFB

Muenster Memorial deployed re|cover™ complemented by an experienced re|solution manager to assist in assessing staff, providing training and re|solution tools left behind for ongoing improvement and success.

Forrest General completes successful system conversion and wind down of legacy accounts receivable

Forrest General deployed re|wind™ complemented by a re|solution project manager to assist in preparing for the conversion with internal staff. Another project manager and team were assigned to work on cash acceleration on the legacy system.

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